DIRECTOR OF REVENUE INTEGRITY

DIRECTOR OF REVENUE INTEGRITY

DIRECTOR OF REVENUE INTEGRITY
Department: 5-9226 Revenue Cycle Administration
Location: Mystic Center Medford MA
Employment Type: Full Time
Job Type: Regular/Non-Union
Union Name: NON - Non Union
Work Shift: 1st shift
Work Days: M-F
Hours Per Week: 40
Date Posted: 08-25-11

1. Manages the Revenue Integrity staff including assigned coders, charge capture specialist and related audit processes to promote efficiency, revenue management, and general direction of the department.

2. Monitor and support daily staff functions in all areas related to the scope of the Director's responsibility.

3. Direct ongoing programs for staff development, which include: hiring and training for staff, completing all necessary human resource documentation and adhering to all human resources expectations, communicating regularly and effectively with staff and superiors regarding the status and condition of the business operations under direct oversight.

4. Incorporate CHA¿s values into all business staff development practices and all departmentally directed activities.

5. Recommend and coordinate use of consultants for specialized activities related to coding, billing, and reimbursements.

6. Keep abreast of regulatory changes, particularly in the areas of medical technology.

7. Review contracts and other information from 3rd party payers to identify revenue opportunities and regulatory requirements.

8. Develop departmental process to review new regulatory developments, evaluate impact on revenue integrity processes, and communicate to other affected departments.

9. Monitor and ensure ongoing compliance with relevant regulations, standards, and directives from regulatory agencies and third-party payers.

10. Performs risk assessment to identify areas of greatest opportunity for process improvement, enhanced charge capture, billing, coding, documentation, and reimbursement.

11. Maintain appropriate internal controls.

12. Monitor the integrity of financial and clinical interfaces as needed to identify gaps in the revenue integrity process.

13. Supervise focused internal and external audits of revenue integrity processes.

14. Plan, coordinate, and prepare audits with external agencies and third-party auditors as they relate to clinical and technical reviews.

15. Communicate audit results including opportunities for process improvement or revenue realization.

16. Participates in the CHA wide efforts related to the RAC program.

17. Mediate and resolve conflicts regarding third-party auditors, and government payers.

18. As appropriate, investigate or refer for investigation, potential compliance issues identified during routine reviews.
1. Active Licensed Registered Nurse credentials required.

2. Bachelor¿s degree in Nursing, Healthcare Finance or related healthcare administration required.

3. Minimum 10 - 15 years progressive management and leadership experience in Revenue Cycle operations, Billing / reimbursement, Internal Audit, Healthcare consulting and/or other relevant healthcare service.

4. Ongoing commitment to continuing professional education and other industry certifications.

Work Experience:
1. Leadership in the core values of a healthcare system and knowledge of day to day activities in hospital operations.

2. In-depth knowledge of Revenue Cycle Operations including hospital and ambulatory operations in a complex, multi-faceted environment.